ET RHTE# /D - S Z3-701/ /Z
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME 7"b 7'C6L4~ x-y- 46.o 7;1 E3yr l~e~s PHONE # 9/5 - 4W - Z331
ADDRESS q A ,46o a -1ii-4A) . 1-' 2--7 Y,
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT) /2e1ct-+ fy(~,,
ADDRESS OF OWNER (IFDIFFERENT) 1,4L
PROPERTY LOCATION: STATE ROAD NAME AND # fy~3 Q'~fr*~
/}may T6 rr o~. c7~ 5'
to C h
PURPOSE OFINSPECTION- ;7ry.r_ ~t~ ~
The aforementioned site has been aluat byte Harnett oun ea 7' eltment
Environmental Health Section. At the time of inspection, there appeared to be a septic
system serving this site. If this system should malfunction, the owner is responsible for
any necessary repairs.
THIS INSPECTION IS VOID IF:
(1) the intended use of the septic system should change, and/or
(2) the system should fail or malfunction, and/or
(3) the owner or tenant of the property changes, and/or
(4) after six months
BUILDING MUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
ature of Environmental Health Specialist
Z--17- lfb
Date
. ,